Extrinsic compression of left main coronary artery due to pulmonary artery aneurysm and pulmonary hypertension.

Idiopathic pulmonary arterial hypertension is a serious condition that carries a poor prognosis. While exertional dyspnea is the most common symptom, angina like chest pain, most often due to right ventricle ischemia, may occur at advanced stages. We present a patient with pulmonary hypertension symptomatic for dyspnea and angina in whom computed coronary tomography angiography showed compression of the left main coronary artery by a large pulmonary artery aneurysm. Percutaneous coronary intervention and stenting was performed resulting in significant clinical improvement. This case emphasizes the role of different cardiovascular imaging modalities for the diagnosis of rare conditions.

Perfil de seguridad de la angioplastia pulmonar con balón bajo anticoagulación con antagonistas de vitamina K / Safety profile of balloon pulmonary angioplasty under anticoagulation with vitamin K antagonists

La hipertensión pulmonar tromboembólica crónica se trata con angioplastia pulmonar con balón (APB) cuando la enfermedad es distal o la clase funcional cardíaca no permite la tromboendarectomía. La anticoagulación con antagonistas de vitamina k es uno de los pilares del tratamiento. Se describe la experiencia de 25 procedimientos de ABP bajo tratamiento anticoagulante con AVK y sus complicaciones de sangrado (8% de las ABP). Realizar APB, con RIN mayor igual a 2 no presenta un riesgo significativo de sangrado en nuestra serie.

Tratamiento hibrido de divertículo de Kommerell complicado / Hybrid treatment of complicated Kommerell's diverticulum

Se describe un caso clínico en el que se aplica una técnica hibrida para el tratamiento del Divertículo de Kommerell complicado por ser una estrategia segura para nuestra paciente. La decisión debe basarse en el conocimiento de la anatomía compleja, el inicio y extensión de la disección como el estado clínico del paciente.

A clinical case is described in which a hybrid technique is applied for the treatment of Kommerell's Diverticulum, complicated by being a safe strategy for our patient. The decision should be based on knowledge of the complex anatomy, the initiation and extent of the dissection as well as the clinical status of the patient.

Mitral valve calcium assessment: An independent predictor of balloon valvuloplasty results.

OBJECTIVE: Percutaneous mitral valvuloplasty (PMV) is an effective treatment for patients with mitral valve stenosis. Echocardiographic score (ES) is a useful predictor of outcomes. However, mitral valve calcification (MVC) has been shown to predict immediate results even in patients with otherwise low ES. We sought to evaluate the usefulness of MVC assessment as a predictor of immediate and long-term outcomes after PMV. METHODS: PMV was performed in 168 consecutive patients. Clinical and echocardiographic variables were analyzed. Patients were classified into 2 groups: group 1: minimal MVC and group 2: moderate to severe MVC. Primary success was defined as post-PMV mitral valve area (MVA) ≥ 1.5 cm2 in the absence of major complications. Restenosis (RE) was defined as a decrease in MVA >50% of initial gain or a final MVA <1.5 cm2. RESULTS: Mean age was 46.5 ± 11 years, and 86.9% (146) were women. Forty-two patients (25%) had mild MVC (group 1), and 75% of the patients had moderate to severe MVC (group 2). Procedural success was achieved in 95.2% and 76.2% for groups 1 and 2, respectively, p = 0.01. MVA after PMV was 1.82 cm2 (IQR 25-75 = 1.60-2.00) in group 1 and 1.67 cm2 (IQR 25-75 = 1.44-1.97) in group 2, p = 0.02. After 48 months, 28.2% of patients presented RE. Multivariate analysis identified the presence of MVC as an independent predictor of poor immediate results (HR = 0.12, 95% IC 0.03-0.91) and RE (HR = 1.94, 95% CI = 1.02-5.21). CONCLUSION: Our study shows that the presence of MVC may predict immediate and long-term outcomes after PMV.

Safety and efficacy of intracoronary sodium nitroprusside for the assessment of coronary fractional flow reserve.

BACKGROUND: Coronary fractional flow reserve (FFR) determination is a valuable tool for the assessment of stenosis significance in intermediate coronary obstructions. Maximal hyperemia is mandatory for this determination. Although intravenous (IV) Adenosine is the standard agent used, its use carries an elevated incidence of side effects. Intracoronary sodium nitroprusside (IC NTP) is a very well-known coronary vasodilator, but it is not routinely used for FFR determinations. OBJECTIVES: The purpose of the present study was to compare FFR determinations and side effect profile of IC NTP with IV Adenosine. METHODS: We prospectively assessed FFR determinations in a total of 20 intermediate coronary artery stenotic lesions in 18 consecutive patients with the administration of IV Adenosine (140 µg/kg/min) and IC NTP (100 µg). The appearance of side effects was registered. RESULTS: The mean age was 55.5 ±â€¯7.5 years. Fifteen (83%) of the patients were male. Mean FFR values with IC NTP were similar to those obtained with IV Adenosine (0.82 ±â€¯0.07 vs 0.82 ±â€¯0.06, respectively, r = 0.775, p < 0.0001). Intravenous Adenosine induced side effects in 45% of patients (shortness of breath 30%, flushing 5%, headache 5%, angina pectoris 5%, and transient conduction disturbances 10%). No side effects were reported with IC NTP. CONCLUSIONS: IC NTP at a dose of 100 µg is as effective as IV Adenosine for FFR assessment. Besides, it is better tolerated and should be consider as a vasodilator agent in the assessment of FFR.